Provider Demographics
NPI:1821053208
Name:MAIN STREET HEALTH ASSOCIATES, P.S.
Entity Type:Organization
Organization Name:MAIN STREET HEALTH ASSOCIATES, P.S.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:NIEHAUS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:509-689-8900
Mailing Address - Street 1:PO BOX 40
Mailing Address - Street 2:
Mailing Address - City:BREWSTER
Mailing Address - State:WA
Mailing Address - Zip Code:98812-0040
Mailing Address - Country:US
Mailing Address - Phone:509-689-8900
Mailing Address - Fax:509-689-9031
Practice Address - Street 1:418 WEST MAIN AVENUE
Practice Address - Street 2:
Practice Address - City:BREWSTER
Practice Address - State:WA
Practice Address - Zip Code:98812
Practice Address - Country:US
Practice Address - Phone:509-689-8900
Practice Address - Fax:509-689-9031
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-19
Last Update Date:2010-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA601803678207Q00000X, 261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7086135Medicaid
WAF20970Medicare UPIN